Acute attacks
Prescribing Notes
- See NICE CG150 “Headaches in over 12s: diagnosis and management”
- Cluster headache management is usually better left to experienced specialists who see this disorder frequently
- Analgesics have no place in treating cluster headache. Ergotamine tartrate, and all orally-administered triptans are of no use as acute therapy
- High flow oxygen is a useful addition to subcutaneous sumatriptan. The oxygen is administered through a high flow regulator and tight fitting mask. A tight fitting non-rebreathing mask should be used. Information on oxygen and other treatments for cluster headache is available from ouchuk.org
- During a cluster, patients may suffer more than one attack daily and require up to 2 doses of sumatriptan in a 24 hour period
- Patients with cluster headache may need to use up to 2 doses of sumatriptan per day throughout their cluster bout. Therefore triptan use should not be restricted to 2 days per week as recommended for migraine
- If sumatriptan injections are unacceptable consider zolmitriptan nasal spray
Prophylaxis
Prescribing Notes
- See NICE CG150 “Headaches in over 12s: diagnosis and management”
- Prophylaxis is indicated during a cluster of attacks (approximately 1-3 months) and should be withdrawn one month after headaches cease
- Most patients will require specialist advice